Mouth Emergencies Not Related to Your Braces

Because they are in treatment, orthodontic patients commonly assume that every canker sore or swelling in the mouth must be related to their braces. How can you distinguish an true orthodontic emergency from just a regular sore in your mouth? When should you go see your orthodontist?

Sores in your mouth may or may not be related to your braces
Oral emergencies common during orthodontic treatment include trauma from outside the mouth (getting hit in the mouth), trauma from inside the mouth (from the braces themselves), irritation from the braces themselves (loose brackets or bent wires), and unexpected results of the treatment (a tooth moves too far). Each of these emergencies is clearly related to having the braces on the teeth. Other emergencies can arise however that are not related to the braces. These include canker sores, fever blisters, blocked salivary glands, swollen lymph nodes, as well as regular dental emergencies (cavities, abscesses, problems with dental work, root canals, etc.).

Not all canker sores are caused by the braces
The most common lesion mistaken for an orthodontic emergency is the garden-variety cold sore or canker sore. Although the braces can irritate the skin inside the mouth, canker sores occur with and without braces. One helpful clue is to note the location of the canker sore relative to the braces. If it perfectly aligned with a part of the braces, they may have actually been the cause of the sore. Many times however, they appear far away from the braces in areas such as deep inside the lip, under the tongue, or inside the cheeks. If they appear adjacent to the metal, wax placed over the irritant and numbing cream (over the counter) will make things comfortable until the sore heals on its own. If there is an obvious structure causing the sore, you should have your orthodontist take a look. As of 2011, there is no cure for the common canker sore.

Fever blisters appear with and without braces
Fever blisters also occur in patients with and without braces. Those who got them before they had braces will usually keep getting them during treatment. Rarely do patients who have never had a blister previously start getting them just because they have braces. Over the counter remedies are also the treatments of choice.

Saliva "bubbles" may occur when very small saliva ducts get blocked
The mouth is full of tiny glands that produce saliva. (Dry the inside of your lip with a piece of tissue in front of a mirror and watch the saliva slowly begin to bead up!) On rare occasions (with or without braces), the ducts of these minor salivary glands get plugged. The result is a swelling or bubble inside the lip or under the tongue. These are officially known as mucocoels. Your dentist treats this by creating an opening so the saliva can drain and the area can heal. He or she should also be consulted in these cases to rule out more dangerous growths that can appear while your braces are on.

Swollen lymph nodes may indicate that there is an infection somewhere
Swollen lymph nodes (usually in the neck) indicate that there is an active infection somewhere in the head and neck region. It might be as simple as acne on the face, but all such swellings should be also be evaluated by your orthodontist and the corresponding infection treated if possible.

Regular dental problems continue to occur even with braces on
The final category of non-braces emergencies that occur in the mouth during treatment are normal dental problems. These include decay, gum disease, and restorations that break down. You should continue seeing your family dentist at regular intervals during orthodontic treatment. If your orthodontist notices a problem with the teeth themselves, he will refer you to your family dentist for repair.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.